Routine

This is the day that the Lord has made;
let us rejoice and be glad in it.
Psalm 118:24

The alarm is set for 5:30. With a cup of fresh Kenyan coffee, a bowl of Weetabix, and a banana, I check the email and have a quiet time while the sun comes up on Mt. Longonot. By 7 or so, I’m ready to head to the hospital.

Each weekday has a different pace and character. Monday starts with medical staff prayer in the conference room, Tuesday with Grand Rounds presented by one of the attending physicians, perhaps a visiting specialist from America or the UK. Wednesday is my favorite morning, with the entire hospital staff packed into the small chapel for singing, prayer, and a word from one of the chaplains. It’s a lively and encouraging time. Thursday and Friday begin with clinical conferences on various topics.

Leaving the conference room, I walk upstairs to Salome to begin the day’s work. Joel, my Clinical Officer, and Catherine, the in-charge nurse, will be there, as will one or two medical students or interns. We take some time to exchange Kenyan greetings, and learn of the new patients who have come in overnight. Then we go around individually to see the patients, reviewing their progress, hunting down reports, and charting plans for the day. Usually I’m caring for about 15 to 20 women. The nurses help me with patients who speak Swahili or Kikuyu, and the Somali-speaking chaplains help with our Somali patients. If the chaplain can’t be there in person, then we pass the patient’s cell phone back and forth! I also go to consult on patients on the surgical services, in Maternity, or in the Private Ward.

We reconvene around 10, and go around as a group to see every patient, discussing their progress and making decisions about their care. We write orders, study Xrays, discuss clinical topics, and plan for procedures such as a spinal tap or thoracentesis. There is much to talk about, for the ward is full and the patients are sick and complex. For those who are interested, we are currently caring for patients with tuberculosis (pulmonary, pleural, periotoneal, and scrofula), cryptococcal meningitis, retropharyngeal tumor, post-meningitis hydrocephalus, lupus cerebritis, diabetic gangrene, peripartum cardiomyopathy, intracranial hemorrhage, amœbiasis, AIDS, PML, thyrotoxicosis, malnutrition, and more.

Kathy fixes a nice lunch for us at home, and then I return to the hospital. On Monday, I’m responsible for the afternoon Private Clinic, where patients can pay more to have a bit more time with a doctor. Tuesday afternoon I work in Outpatient, where there is always a large crowd of patients waiting to be seen by me or by one of the Clinical Officers. In the center of things is an oval counter with a rack of charts and reports, with patients, nurses, aides, and doctors all around. From a distance, the hubbub could resemble the floor of the NY Stock Exchange! I’m usually on call on Tuesday, so I stop by Casualty and ICU to check on things before heading home for supper.

Wednesday and Friday afternoons are spent finishing things up on the ward, and if time permits, making a trip to the dukas with Kathy, or taking a walk as the sun sets over the Rift Valley. Thursday I walk up the hill to Rift Valley Academy, and see students in the Health Center; I like to swing by the school library and check out a DVD for Kathy and me to watch on the weekend. Our friend Edward comes at 4 on Monday and Thursday afternoons for our Kiswahili lesson. After supper, we visit with friends, play a card game, or just enjoy reading. Saturday rounds are usually finished around noon, and then (except when I have weekend call) I’m off until Monday.

Sunday we enjoy going to the African church up the hill for worship at 8:30. Sometimes we’ll buy lunch at the RVA cafeteria at noon, and maybe take a walk to the forest. There’s a group that plays ultimate Frisbee on Sunday afternoons; they let me play even though I’m easily the oldest one out there.

I enjoy what I’m doing, and the people I’m working with. It’s challenging and rewarding, but also tiring. Kathys’ week is full as well. We’re going to take a short break next week and stay in a little cottage on a farm west of Nakuru. It will be good to get away.

- Doug